Provider Demographics
NPI:1942945175
Name:CRESCENT DRUG AND APOTHECARY LLC
Entity Type:Organization
Organization Name:CRESCENT DRUG AND APOTHECARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORINASH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:405-665-4115
Mailing Address - Street 1:116 S DEAN A MCGEE AVE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-7822
Mailing Address - Country:US
Mailing Address - Phone:405-665-4115
Mailing Address - Fax:405-665-5666
Practice Address - Street 1:116 S DEAN A MCGEE AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-7822
Practice Address - Country:US
Practice Address - Phone:405-665-4115
Practice Address - Fax:405-665-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy